IV 5% Dextrose Administration Rate for Starvation Ketosis
For starvation ketosis, IV 5% dextrose should be administered at a rate of 7 mg/kg/min (equivalent to 100 mL/kg per 24 hours) with appropriate maintenance electrolytes. 1
Dosing Guidelines
- For pediatric patients, 5% dextrose (D5W) should be administered as a constant infusion with appropriate maintenance electrolytes at 100 mL/kg per 24 hours, which equals approximately 7 mg/kg/min 1
- For adults, the maximum rate at which dextrose can be infused without producing glycosuria is 0.5 g/kg of body weight/hour (approximately 95% of dextrose is retained when infused at a rate of 0.8 g/kg/hr) 2
- Titrate the rate to achieve normoglycemia, as hyperglycemia can have adverse central nervous system effects 1
Formulation Considerations
- 5% dextrose (D5W) is the preferred concentration for treating starvation ketosis 1
- Higher concentrations like D50W are irritating to veins; dilution to 25% dextrose or lower is desirable 1
- For peripheral vein administration, injection of the solution should be made slowly 2
Monitoring Parameters
- Blood glucose levels should be monitored carefully during treatment 1
- Sodium and potassium levels should also be monitored regularly 1
- For patients receiving insulin infusions alongside dextrose, blood glucose should be monitored every 1-2 hours 1
Clinical Considerations
- Starvation ketosis typically resolves rapidly with dextrose administration 3
- A case report showed that administration of 5% dextrose in water (1L over 24 hours) successfully resolved starvation ketosis 3
- Dextrose administration leads to a greater reduction in serum ketone levels compared to normal saline alone 4
- In non-diabetic ketoacidosis, dextrose administration helps reverse the ketotic state by providing carbohydrates that reduce ketone production 5
Potential Pitfalls
- Hypoglycemia may recur depending on the etiology, requiring continued monitoring 1
- Rapid administration of concentrated dextrose solutions may lead to complications such as cardiac arrest and hyperkalemia 1
- Overtreatment with dextrose can lead to hyperglycemia, which has its own adverse effects 1
- For patients with diabetes-related ketoacidosis, different protocols apply, including adjusting insulin infusion rates when blood glucose falls below certain thresholds 6
By following these guidelines for IV 5% dextrose administration in starvation ketosis, you can effectively reverse the ketotic state while minimizing potential complications.